Monkeypox Home Isolation Guidance for the General Public
Monkeypox (MPX) virus can be spread from the time symptoms start until all MPX lesions have fully healed and a fresh layer of skin has formed at the skin lesion sites (the rash or sores). MPX virus can spread person-to-person through:
Direct skin-to-skin contact with the lesions or scabs, or direct contact with body fluids such as drainage from skin lesions or saliva that was in contact with oral lesions.
Respiratory secretions, such as saliva, during prolonged, face-to-face contact or during intimate physical contact, such as kissing, cuddling, or sex.
Touching items (such as objects, surfaces, clothing, and linens such as bedding and towels) that previously touched lesions or body fluids from people with MPX. More rarely, handling contaminated linens could release MPX virus into the air, potentially enabling inhalation of virus. MPX virus can survive for varying lengths of time on surfaces or objects (though it is still unknown as to how long the virus remains on different types of surfaces).
Across the placenta from a pregnant person with MPX to their fetus.
We are still learning about the likelihood of person-to-person transmission of MPX virus through each of these routes. However, it is thought that the most common route of transmission during the 2022 global MPX outbreak is direct (i.e., skin-to-skin) contact with MPX lesions, including but not limited to contact that occurs during sexual activity and close contact within households.
MPX lesions are infectious at all stages until lesion scabs separate and a fresh layer of skin has formed at lesion sites.
Lesions may be present in locations that are not externally visible such as the mouth, throat, anus, or vagina.
MPX virus may be present in other body fluids, including blood, urine, feces, and semen. However, it is not known if or how transmission can occur via those routes.
Children less than 8 years of age, persons with skin conditions such as atopic dermatitis or eczema, persons with immunocompromising conditions or treatments, persons with HIV infection and a CD4 count <350/mm3 and pregnant or breastfeeding persons are at greater risk of severe MPX infection. In the current outbreak, more than 98% of people with MPX have been adults and have not required hospitalization. The West African MPX virus is the cause of the current outbreak and historically this virus has an approximately 1% fatality rate, particularly among people who do not have a fully functioning immune system. To date, no deaths have been reported in the United States, but a small number of deaths have been reported outside of Africa, including Spain, Brazil and India.
The following recommendations apply to people with confirmed MPX and those with MPX symptoms while waiting to be evaluated or for test results. There is no requirement for public health departments or healthcare providers to monitor cases during their isolation period aside from providing standard medical care. Local health departments may elect to monitor some cases in high-risk situations.
People with confirmed or suspected MPX should:
A. Isolate at home
Stay home unless it is necessary to see a healthcare provider, do not resume activities outside the home, and do not return to the workplace (see return to work section below) until:
MPX infection has been ruled out; OR
Criteria in Section B (below) are met; OR
All MPX lesions are fully healed and a fresh layer of skin has formed at lesion sites and any other symptoms have been resolved for at least 48 hours.
1) Persons with MPX who live with other people should take the following precautions at home until all skin lesions are healed (i.e., scabs have fallen off, a fresh layer of skin has formed at the lesion sites), and other symptoms have been resolved for at least 48 hours:
If an uninfected person in your household is at high risk of severe disease (see above), it might be necessary to isolate outside the home.
Avoid close contact with other people and animals or pets in the home; follow CDC guidance with regard to animals and pets.
Keep skin lesions covered (see below).
Stay in a separate room and use a separate bathroom, if possible. If the same bathroom must be used by others, it should be cleaned and disinfected after use by the person with MPX.
When in the same room, both the person with MPX, as well as other household members, should wear a respirator or a well-fitting mask when in close contact (e.g., within 6 feet) for more than a brief encounter (see #3 below for more information).
Clean and disinfect frequently touched items following CDC guidance. If cleaning and disinfection is done by someone other than the person with MPX, that person should wear, at a minimum, disposable gloves and a respirator. If cleaning and disinfection is done by someone other than the person with MPX, that person should wear, at a minimum, disposable gloves and a respirator.
Disinfect or launder items that have been worn or handled by the person with MPX, following CDC guidance. Persons with MPX should handle their own laundry, if possible, and shaking of linens should be avoided. If laundry is done by someone other than the person with MPX, that person should not shake laundry, and, at a minimum, should cover arms, and use disposable gloves and a respirator.
Avoid kissing, hugging, cuddling, sleeping in the same bed, or having sex or other close skin-to-skin contact with other people.
Avoid sharing bedding, towels, utensils or cups, and electronics. Potentially contaminated items should be cleaned and disinfected before use by others.
Avoid activities that may put viral particles in the air, like dry dusting, sweeping, and vacuuming.
Wash hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after direct contact with lesions. Other household members should also clean their hands frequently.
2) Cover unhealed skin lesions to the extent possible if living with or in contact with other people.
Cover lesions with clothing, or a piece of gauze held in place with first aid tape or a semi-permeable bandage (one that allows air to flow through, but not fluids), e.g., Tegaderm™ with a gauze pad or similar.
Wear gloves to cover lesions on hands.
Prevent lesions from touching other people or items that may be used by others (bedding, towels, clothing, furniture, door handles, sex toys, cutlery, etc.).
Follow healthcare provider recommendations on the care of lesions.
Seek medical attention if there are any signs of a secondary bacterial infection, including fever, pus, or increasing warmth, redness, and swelling in the skin surrounding the lesions.
Changing bandages should be performed by the person with MPX while wearing disposable gloves. Wash hands immediately following glove removal and disposal.
If assistance is needed with cleaning or caring for skin lesions, including bandaging, the person helping should wear, at a minimum, disposable gloves, long sleeves, and a well-fitting mask or respirator.
Any clothing that contacts the lesions during bandage changes should be immediately laundered.
Contain and dispose of contaminated waste (e.g., bandages, gloves) following CDC guidance.
3) Wear a respirator or well-fitting mask at all times when in contact with other people until all skin lesions have healed and other symptoms have been resolved for at least 48 hours.
Respirators, such as NIOSH-approved N95 respirators, offer the most protection.
If an N95 respirator is unavailable, other types of respiratory protection can be considered, such as KN95 and KF94 respirators (more protection), ASTM F3502-21 barrier face coverings, or surgical masks (less protection).
Respirators or masks should be well-fitting (i.e., fit closely on the face without gaps along the edges or around the nose) and be comfortable when worn properly (covering the nose and mouth). Use the most protective mask that fits well and will be worn consistently.
4) Persons isolating for MPX infection should take the following precautions even if they don't live with other people:
B. Resume limited activities outside the home
Activities outside the home that do not involve settings of concern* or physical contact with other people may be resumed without medical clearance once all of the following criteria are met:
Any fever or respiratory symptoms have been resolved for at least 48 hours; AND
No new lesions have appeared for at least 48 hours; AND
Any lesions that cannot be covered, such as those on the face, are fully healed (scabs have fallen off and a fresh layer of skin has formed at the lesion sites).
Once all of the above criteria are met, persons with MPX may resume limited activities outside the home using the precautions below:
Cover any unhealed lesions with clothing or bandages.
Wear a well-fitting respirator or mask at all times when in contact with other people (see #3 above for more information).
Wash hands frequently with soap and water or an alcohol-based hand sanitizer and avoid direct contact with lesions.
Do not share towels or other personal objects with others.
Avoid crowded settings such as bars, clubs, parties, saunas, and bath houses.
Avoid direct skin-to-skin contact or intimate physical contact with others including kissing, cuddling, and sexual contact.
Return to work considerations are specifically noted below.
C. Return to work
Workers may return to non-settings of concern* when they meet all the criteria in Section B above, AND all of the following conditions are met:
Employment does not involve direct physical care or contact with others, e.g., massage therapy, estheticians, sex work, etc.;
Employment is not in a setting of concern;* AND
Virtual work is not possible.
If these conditions for return to work are not met, persons with MPX should not return to work until their skin lesions are fully healed and other symptoms have been resolved for at least 48 hours, as described in Section D below.
Virtual work options and paid leave should be explored. For more information about paid leave options, please see the California Employment Development Department site and the Leave Benefits | U.S. Department of Labor (dol.gov).
Workers who are employed or actively looking for work and who are unable to do their regular or customary work for at least eight days may qualify for financial support from California's State Disability Insurance (SDI) program. Note that the affected individual must be under the care and treatment of a licensed physician/practitioner who must complete the medical certification portion of disability claim.
*Settings of concern include:
Homeless shelters, migrant shelters, emergency shelters, and residential drug treatment facilities
State and local correctional facilities and detention centers
Long-term care, adult and senior care facilities, and in-home services involving physical care
Childcare and preschool settings that provide care for children from infancy through pre-school, assuming that there will be close physical contact for diapering, toileting, feeding, hygiene and general interaction
K-12 schools and other settings (before/after school programs) that provide care for school-aged children younger than age 8 or older children whose care requires close physical contact, if job duties require direct physical contact with such children
Persons with MPX who work in a setting of concern should not return to the workplace until all skin lesions have healed (i.e., scabs have fallen off and a fresh layer of skin has formed at the lesion sites) and any other symptoms have been resolved for at least 48 hours, as described in Section D. Before returning to a setting of concern, consultation with a healthcare provider or local health department is advised.
Employers whose workplaces and employees are covered by the Cal/OSHA Aerosol Transmissible Diseases Standard should consult those regulations for additional applicable requirements. Some workplaces may also have additional requirements required by their licensing and certification bodies.
D. Resume normal activities
Once all skin lesions have healed (i.e., scabs have fallen off and a fresh layer of skin has formed at the lesion sites) and any other symptoms have been resolved for at least 48 hours, persons with MPX can resume normal activities.
Evidence on MPX transmission via genital excretions is lacking, and a precautionary approach for the use of condoms during sexual activities for 12 weeks after infection is recommended while scientists and public health officials seek to understand whether MPX virus remains in semen and/or can be spread through sexual activity, even after skin lesions are healed.